Working through breast refusal: What to know and what to do

Here you are, dripping milk, all ready for your baby to feed – but he won’t!

If you have a newborn, there is every chance you will be ‘woman handled’ as somebody tries to get your baby to latch by grabbing baby and boob and shoving them together (if this happens, put your hand up in a stop sign and ask, ‘please can you guide me, I would like to try myself’). Or, if your baby is older and has been happily breastfeeding until now, you are probably wondering, ‘is he weaning?’

Whatever the reasons for your baby’s breast refusal, your baby isn’t ‘refusing’ to breastfeed because he is being stubborn and forcing him won’t help. For newborns, generally if your baby won’t breastfeed it is because he can’t right now, but it doesn’t mean you won’t be able to breastfeed at all – although you will need to be patient, with the right help, most babies will ‘catch on’ and latch on. Reasons for your newborn not being able to breastfeed in the early days may include being affected by drugs that you have taken during labour – being able to latch on and coordinate sucking, swallowing and breathing isn’t easy when your central nervous system is ‘hung over’ by drugs such as pethidine which pass through the placenta to your baby, staying in their body for several days or longer. Some drugs given by epidural have been found to affect breastfeeding for up to four weeks.

Early feeding attempts can also be affected by a difficult birth. For instance, babies who have had a forceps delivery may have some pain when they feed, others could be in pain in particular positions if, for instance, they have a sore shoulder or clavicle after birth. These babies often benefit from some gentle adjustments by a paediatric osteopath or chiropractor (it is important that any practitioner is trained to treat infants).

Other babies may have difficulty latching on due to problems with their oral anatomy such as a high palate (which can be helped by careful breastfeeding positioning) or a tongue tie (this can be easily remedied by seeing a Dr who will ‘snip’ the tongue tie). And some babies seem to develop an ‘aversion’ to breastfeeding after being ‘forced’ to breastfeed (your baby has a natural reflex to resist if his head is pushed forwards – don’t ever push your baby’s head against the breast).

Another possible reason for ‘breast refusal’ could be nipple confusion: bottles and dummies require a completely different sucking action to the breast and babies can become ineffective at breastfeeding if they are given bottles in the early days. If your newborn is having difficulty feeding at the breast, it is better to offer supplements by spoon or a syringe, or you could use a ‘nursing supplementer’, a device with fine tubing that slides into baby’s mouth, so he gets milk while he is at the breast. If you do have to temporarily offer some feeds from bottles, please don’t feel ‘this is the end’. With patience and persistence, even though it may take a few weeks, it is possible to gradually encourage your baby to breastfeed.

Is baby unwell or ‘on strike’?

After the early days, even babies who have been feeding beautifully can refuse to breastfeed or seem to struggle at the breast. A baby who has oral thrush may find it uncomfortable to breastfeed and a baby who has gastro oesophageal reflux can squirm and pull off the breast if feeding is causing discomfort. A baby with reflux may find it more comfortable to feed ‘sitting up’ perhaps straddled across your leg to feed. Babies with allergies can also seem restless during feeds or may reject the breast.

Although your baby is NEVER allergic to your milk, if he is sensitive to something in your own diet, a bit of detective work and eliminating the culprit food can make all the difference.

Older babies can seem to be rejecting the breast as they become more efficient feeders so feed more quickly and are also easily distracted; painful teething can see babies ‘go on strike’; babies who have been given bottles can almost suddenly seem to ‘prefer’ drinking from a bottle and other babies can refuse the breast for reasons that aren’t at all obvious.

What can you do?

Whatever the reasons for your baby refusing to breastfeed, the most important considerations are to feed your baby (please don’t EVER try to ‘starve’ him into taking the breast), and to maintain your milk supply, by expressing so that when your baby does attempt to feed, his efforts will be rewarded by good milk flow.

Offer lots of skin to skin contact – wear clothes with quick access to the breast and cuddle your baby with your top off, allowing him to fall asleep on you. Wear, cuddle and carry baby lots and sleep with or close to him, so you can offer the breast at his very first hunger cues.

Try feeding in different positions and at different times – lying down, standing or walking, in the bath. Try offering the breast as baby is just waking, as he is falling asleep or when he is asleep but stirring slightly.

Don’t try to pressure your baby to feed. Stay calm (not always easy!) and avoid making your baby frustrated. If he is becoming stressed, feed him however you have been and try again later. If baby is having bottles, he may try the breast after he has had a little drink, rather than when he is very hungry.

Be patient. It can take time for babies to learn to feed effectively but this can happen more quickly with expert help from a breastfeeding counsellor or lactation consultant.

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About Pinky McKay

Pinky McKay, International Board certified Lactation Consultant (IBCLC), runs a private practice in Melbourne specializing in gentle parenting techniques. A sought after keynote speaker and best-selling author with 4 titles published by Penguin, including her recent book Parenting By Heart, she’s an expert source for media appearing regularly on major network TV and quoted in various publications. Pinky’s books, parenting resources and her free newsletter ‘Gentle Beginnings’ can be found on her website www.pinkymckay.com.au